Scar revisions…are they worth it?

As a Plastic Surgeon I get a lot of requests to check patients to see if they are a candidate for scar revision surgery. A lot of times the answer is a quick, easy “Yes” but not always. And when I tell the patient that I can’t help they are usually fairly unhappy so I want to go over what I, as a plastic surgeon, am thinking when I see a scar.

First, I want to know how old it is. It takes at the very least 6 months to get a good idea of what a scar may turn out like. A lot of times what looks pretty bad at a month or two ends up looking quite good by the 9-12 month point. 1 year is the usual point where I will consider a surgical revision.

Secondly, I want to know the circumstances that left the scar. If the scar resulted from a traumatic laceration I am more willing to consider revision. Traumatic lacerations are usually dirty wounds that involve a crush component to the wound edges. This is not very favorable and can leave a worse scar. If on the other hand, the scar resulted from a surgical procedure I am not quite as willing to take a revision on because the wound was already repaired by a trained surgeon under ideal circumstances.

Third, the location of the scar is important. Any scar over a joint, on the upper back, or the upper mid chest is not going to heal well no matter who sewed the cut up the first time. These areas are just very unfavorable. So location in important.

Your biology is important. If you have a keloid scar or a hypertrophic scar, well these are errors in wound healing that tend to be genetic. There are some things we can try to defeat these problems but unfortunately, especially with keloids, your genes win and the scar returns. Bottom line is some people just don’t heal as well as others and there is nothing I can do to change that.

Finally, if you have a scar and want it completely gone, well that is impossible. It ranks right up there with getting rid of stretch marks. Sounds good but it isn’t gonna happen.

So if you have a scar and your surgeon tells you “I can’t help” there are a lot of good reasons and probably a lot of experiences behind that statement.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

How long will the swelling last after my surgery?

Well, it obviously depends on what type of surgery you have and on what part of the body, but there are some general guidelines that we can talk about. First, any time we operate on soft tissue be it a breast surgery, liposuction, or a tummy tuck or any facial surgery, we are wounding your tissues. Now we are wounding them under the most ideal circumstances e.g. anesthesia, sterility etc… but we are still doing surgery and this causes some trauma to the tissues. Our bodies are programmed to heal via a pre programmed cascade of which Inflammation is a key component. Now, the irony is that most hear the word ‘inflammation’ and have negative connotations, but inflammation is a normal and very critical component of tissue repair. What happens is that within and adjacent to the area where the surgery occurred, the blood vessels become leaky, like a soaker hose. Blood vessels are tubes with lots of holes in them to allow the cells that promote healing to be delivered to the injured area. As the cells escape the blood stream to heal, they pull water with them. That is called osmosis, think back to Biology 101. So there is extra water in the area. Now, to compound the problem, when there is extra water/swelling fluid the body gets rid of this via the tiny venous and lymphatic channels that course through our body. Well, the surgery usually disrupts these channels and new ones have to form. This process usually takes a several weeks to months. That’s why after cosmetic procedures, your surgeon will usually caution you to expect some swelling for at least 6 weeks and probably for 3-6 months post operatively. Areas that are particularly prone to swelling are the extremities, especially the legs. Anatomically, your leg is technically from your knee to your ankle. Because of gravity, this area swells the most and heals the most slowly. The head and neck areas also swell because the blood supply to this area is very robust and so there are just more ‘soaker hose’ vessels to leak during the inflammatory phase of wound healing. The take home message here is that swelling is a normal healthy part of healing. Your surgeon will discuss how much swelling and for how long based on your planned procedure and area to be treated.

Lee Corbett, MD